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A practical guide to critical parameters in acute care testing such as pO2, lactate and troponin

Critical parameters in acute care testing

Radiometer's acute care testing handbook is offering a practical guide to critical parameters in acute care testing such as pO2, lactate and troponin

Register here to download the acute care testing handbook and to be sure to receive information on any future updates.

Index of critical parameters in the handbook:

Oxygen status 

  • Oxygen uptake
  • Oxygen transport/delivery
  • Oxygen release
  • Lactate and tissue oxygenation
  • The patient's oxygen status - flow chart
  • Description of the flow chart

 

Oxygen partial pressure – pO2   

  • Reference interval pO2 – examples
  • Physiological significance of pO2
  • Why measure pO2 ?
  • When should pO2 be measured ?
  • Clinical interpretation
  • Causes of hypoxemia
  • Symptoms associated with hypoxemia
  • Causes of hyperoxemia

 

Hemoglobin – Hb  

  • Reference interval Hb – examples
  • Hemoglobin : structure & function
  • Why measure ctHb ?
  • Causes of decreased ctHb
  • Symptoms of decreased ctHb 
  • Causes of increased ctHb
  • Symptoms of increased ctHb

 

Oxygen saturation – sO2   

  • Reference interval sO2 – examples
  • Physiological background – sO2
  • Why measure sO2 ?
  • When should sO2 be measured ?
  • Causes of decreased sO2
  • Symptoms associated with decreased sO2
  • Three ways of assessing sO2 in critically ill patients ?

 

Oxyhemoglobin – O2Hb  

  • Reference interval O2Hb – example
  • What is O2Hb ?
  • Causes of decreased FO2Hb
  • FO2Hb versus oxygen saturation (sO2)

 

Oxygen content – ctO2   

  • Reference interval ctO2 – examples
  • Delivery of oxygen to tissue cells
  • Why measure ctO2
  • Causes of decreased ctO2

 

p50  

  • Interpretation of p50 values
  • Reference interval p50 – examples
  • The oxyhemoglobin dissociation curve (ODC) and concept of p50
  • Reasons for determining p50
  • Causes of increased p50
  • Causes of decreased p50
  • Diagnostic value of p50 – examples

 

Carboxyhemoglobin – COHb  

  • Reference interval COHb – examples
  • What is COHb ?
  • When should COHb be measured ?
  • Causes of increased COHb
  • Interpretation of COHb in cases of delayed measurement
  • Blood oxygenation during carbon monoxide poisoning

 

Methemoglobin – MetHb  

  • Reference interval MetHb – example
  • What is MetHb ?
  • When should MetHb be measured ?
  • Causes of increased MetHb
  • Symptoms of methemoglobinemia
  • Cyanosis in methemoglobinemia

 

Shunt  

  • Reference interval shunt – example
  • Ventilation/perfusion ratio, dead space and shunt
  • Why determine the FShunt ?
  • When should FShunt be determined ?
  • Interpretation guidelines for FShunt in critically ill patients fitted with a pulmonary catheter
  • Causes of increased FShunt
  • Symptoms associated with increased FShunt

 

Acid-base status  

  • The Siggard-Andersen acid-base chart
  • Defining terms used in interpretation of acid-base status
  • Acid-base flowchart

 

pH  

  • Reference interval pH – examples
  • Why measure pH ?
  • When should pH (pCO2 and HCO3–) be measured ?
  • Causes of acid-base disturrbances
  • Symptoms of acid-base disturbances
  • Clinical interpretation
  • Fetal scalp pH and umbilical-cord pH
  • pH in pleural fluid

 

Carbon dioxide partial pressure – pCO2   

  • Reference interval pCO2 – examples
  • Physiological significance of pCO2
  • Why measure pCO2 ?
  • When should pCO2 (pH and HCO3–) be measured ?
  • Causes of increased pCO2
  • Causes of decreased pCO2
  • Symptoms related to pCO2 imbalance
  • Symptoms of increased and decreased pCO2
  • Clinical interpretation

 

Bicarbonate – HCO3– 

  • Reference interval HCO3– examples
  • Physiological significance of HCO3
  • Why measure HCO3– ?
  • When should HCO3– (pH and pCO2) be measured ?
  • Clinical interpretation
  • Causes of decreased HCO3
  • Causes of increased HCO3
  • Symptoms related to HCO3– imbalance
  • The distinction between actual and standard HCO3

 

Base Excess – BE  

  • The concept of BE
  • Reference interval cBase (Ecf) – examples
  • Actual base excess (cBase(B) or ABE)
  • Standard Base Excess (cBase(Ecf) or SBE)
  • Why determine BE ?
  • Clinical interpretation
  • Causes of abnormally negative BE
  • Causes of abnormally positive BE

 

Anion Gap – AG  

  • Reference interval AG – examples
  • Concept and clinical significance of AG
  • Why determine AG ?
  • Metabolic acidosis and AG
  • Clinical interpretation
  • Causes of increased AG
  • Causes of decreased AG

 

Potassium – K+   

  • Reference interval K+ – examples
  • Distribution and physiological significance of potassium
  • Why measure potassium ?
  • Physiological control of extracellular fluid potassium concentration
  • Causes of hypokalemia
  • Symptoms of hypokalemia
  • Causes of hyperkalemia
  • Symptoms of hyperkalemia

 

Sodium – Na+   

  • Reference interval Na+ – examples
  • Distribution and physiological significance of sodium
  • Why measure sodium ?
  • Sodium balance
  • Terms used in interpretation of sodium
  • Causes of hyponatremia
  • Symptoms of hyponatremia
  • Causes of hypernatremia
  • Symptoms of hypernatremia
  • A note on pseudohypo- and pseudohypernatremia

 

Chloride – Cl–   

  • Reference interval Cl– – examples
  • Distribution and physiological significance of chloride
  • Why measure chloride ?
  • Chloride balance
  • Terms used in interpretation of chloride
  • Causes of hypochloremia and hyperchloremia
  • The value of chloride in the investigation of acid-base disturbance
  • Causes of ”high-AG” acidosis
  • Causes of ”normal-AG hyperchloremic”acidosis
  • Acid-base disturbances associated with abnormal chloride

 

Ionized calcium – Ca2+   

  • Reference interval Ca2+ – example
  • Distribution and physiological significance of calcium
  • Why measure calcium ?
  • Regulation of calcium
  • Terms used in interpretation of calcium
  • Causes of hypocalcemia
  • Symptoms of hypocalcemia
  • Causes of hypercalcemia
  • Symptoms of hypercalcemia

 

Glucose  

  • Reference interval glucose – examples
  • Physiological significance of glucose and blood glucose regulation
  • Why measure blood/plasma glucose ?
  • When should glucose be measured ?
  • Hyperglycemia and diabetes
  • Hyperglycemia and the critically ill
  • Causes of hyperglycemia
  • Symptoms of hyperglycemia
  • Hypoglycemia
  • Causes of hypoglycemia
  • Symptoms of hypoglycemia
  • Hypoglycemia and neonates
  • Causes of hypoglycemia in neonates include

 

Lactate  

  • Reference interval lactate – examples
  • Physiological significance of lactate
  • Why measure lactate ?
  • When should lactate be measured ?
  • Clinical interpretation
  • L- and D-lactate

 

Bilirubin  

  • Reference interval bilirubin – examples
  • Bilirubin metabolism
  • Types of bilirubin found in plasma
  • Why measure bilirubin ?
  • When should bilirubin be measured ?
  • Interpretation of bilirubin values
  • Physiological classification of jaundice
  • Physiological jaundice of newborns
  • Treatment for hyperbilirubinemia/jaundice in newborns
  • Action limits for treatment of newborns with jaundice ?

 

Creatinine  

  • Reference interval creatinine – examples
  • Creatinine biochemistry and physiology
  • Why measure creatinine ?
  • When should creatinine be measured ?
  • Clinical interpretation
  • How is creatinine used to diagnose and stage AKI ?
  • How is creatinine/GFR used to diagnose and stage CKD ?
  • Symptoms of CKD
  • Causes of CKD
  • Nephrotoxic drugs
  • Estimating glomerular filtration rate
  • Estimating GFR equations recommended by NKDEP

 

Cardiac troponins – cTnI and cTnT  

  • Physiological significance of troponin
  • Cardiac troponins and Myocardial Infarction
  • When should cTnI/cTnT be measured
  • Clinical indications for cTnI or cTnT request
  • Defining a positive troponin result
  • Troponin levels in patients suffering from MI
  • Non-MI causes of increased cTnI and cTnT

 

Natriuretic peptides – BNP and NT-proBNP  

  • BNP and NT-proBNP – background physiology
  • Specimen collection for BNP and NT-proBNP
  • BNP and NT-proBNP in healthy individuals
  • BNP and NT-proBNP for diagnosis of heart failure
  • The prognostic utilization of BNP and NT-proBNP in HF

 

D-dimer  

  • What are D-dimers ?
  • D-dimer and venous thromboembolism (VTE)
  • Causes of increased D-dimer not associated with VTE
  • Why measure D-dimer?
  • Clinical utility of D-dimer test not confined to VTE
  • When should the D-dimer test be considered ?
  • Interpretation of D-dimer test results

 

C-reactive protein – CRP  

  • Background pathophysiology
  • CRP reference values – what is normal ?
  • The distinction between CRP and hsCRP measurements
  • Causes associated with increased CRP
  • Clinical utility of CRP

 

Human chorionic gonadotropin – hCG  

  • hCG and its variants
  • Background physiology – pregnancy and hCG
  • Reference plasma hCG values
  • hCG in the early diagnosis of pregnancy and early pregnancy loss
  • Use of hCG in diagnosing ectopic pregnancy
  • Monitoring role of hCG following pregnancy loss and ectopic pregnancy
  • Causes of increased hCG outside of pregnancy

 

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